Electronic patient flow – eliminating inefficiency and optimising resources

John RoebuckInterim Programme Director – IM&T

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The case for electronic referrals

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Source : Age UK Published on 17 June 2015

In the last year alone, April 2014 to March 2015, shortages in community health and social care services have meant the NHS has wasted hundreds of thousands of bed-days whilst patients wait for the right care and support in the right place, including;

174,138 days waiting for a place in a residential home

215,662 days waiting for a nursing home place to become available

206,053 days for help from social care workers or district nurses to enable people to return to their own home

41,389 days for home adaptations ranging from grab rails to ramps and stair lifts.

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Cumbria CCG position – Paper Free at Point of Care

•CCG invested in e-referral and resource matching software (Strata pathways) in October 2012 for all health and care providers. •Began implementing in Feb 2013 and undertaken roll outs across health and care providers over the past 3 years

•Integrating the e-referral software with prime electronic patient records of our providers; Lorenzo, Realtime, EMIS, Liquid Logic, Rio, ERISS

•Steady increase in roll out of e-referrals; currently 1600 e-referrals per month – expect this to double by end 2017

•Support from AHSNs and NHS England has helped to facilitate roll out of software to front line staff

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University Hospitals of Morecambe Bay

•3 hospitals• 58 different teams responsible for referring patients onto other health and care services across South Cumbria and North Lancashire •Over past 12 months, average of 1000 referrals per month•Furness General (23), Westmorland General (9) and Royal Lancaster(26) referral points•772 different combinations of referrals

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Electronic patient flow at UHMBUse of e-referrals and resource matching for:•Assessment, Discharge & Withdrawal notices – Care Act 2014, Schedule 3•Community nursing services•Step down community hospitals•Continuing healthcare - fast track, checklist and DST•Palliative care•Child safeguarding•Occupational therapy services•Drug and alcohol services

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Dynamic Interoperability•UHMB Lorenzo EPR integrated with Strata•CCC ASC - Liquid Logic integrated with Strata (awaiting access to NHS Number)•Single sign on for staff to access e-referrals•Bespoke electronic forms, designed by front line staff•Demographic and clinical data transferred from Lorenzo into e-referral•Fully electronic transmission of information•Ability to track progress of referral into receiving organisation, viewable by sender and receiver •Bespoke Performance indicators for different care types

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Addressing Inefficiencies

Annual efficiency savings of £400k per annum and rising•Reduced time sending and receiving referrals / filing / photocopying•Care navigation undertaken automatically•Timeliness of referrals•Transparency between senders and receivers – track progress of referrals•Quality of patient / clinical data•Reduction in paper / fax costs

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Optimising resources

• Staff satisfaction• Workflow Efficiency• Complete and Accurate Referral Intake Data• Process and Status Transparency• Decision Support – proactively manage

blockages in care pathways• Improved Communication• Real-Time, Centralised Patient Flow Data• Comprehensive Reporting and Business

Intelligence• New data sets – Ability to audit pathways

across acute, community and social care

Dynamic interoperability

Referrals displayed in order of arrival

Referral status’ clearly displayed-Received-Cancelled-Request for Information

Warning triangles highlight breach of KPI

Various permutations to search on

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Cumbria ASC staff feedback

•Broken down the Berlin wall between health and social care•Referrals are wonderfully clear•Greater appreciation of hospital activities•Improved communication and goodwill•Standardised electronic forms used across Cumbria•Flexible system with changes made promptly from front line staff feedback •Catalyst for business change

Strata Social Care Team – YouTube

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Val Stangoe, CX, St Mary’s Hospice •Stepping away from faxed referrals provides a patient data transfer system which is much more secure • Because the form is on line with all information required for completion the quality of referrals has gone up. This means patients have to revisit less of their story on meeting new staff which reduces stress for patients and families• Because community staff can see what beds are available they are clear in advance that there is a good chance of patient admission; this means less frustration for families awaiting information •Quicker contact between agencies

John RoebuckInterim Programme Director – IM&T

Tel: 01768 245240email john.roebuck@cumbriaccg.nhs.uk